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AIMS: Using routine HbA1c measurement to determine the prevalence of diabetes mellitus (known and previously unrecognized) and their hospital outcomes among hematology and oncology inpatients. METHODS: This was a prospective, observational study. Routine automated HbA1c testing was performed in all hematology and oncology inpatients aged ≥54â¯years at a tertiary hospital, July 2013-January 2015. The outcome measures were: (i) prevalence of known and previously unrecognized diabetes, and (ii) hospital outcomes: length-of-stay (LOS), intensive-care-unit (ICU) admission, 30-day/18-month readmission, and 18-month mortality. RESULTS: Over the 18-month study period, 1076 inpatients aged ≥54â¯years were admitted to hematology (nâ¯=â¯298) and oncology (nâ¯=â¯778) units: 21% had known diabetes and 7% had previously unrecognized diabetes. Patients with known diabetes had a longer LOS (IRR: 1.18, 95%CI: 1.02-1.37, pâ¯=â¯0.03), compared to those without diabetes, adjusting for age, hemoglobin level, estimated-glomerular-filtration-rate, admission specialty unit, Charlson's comorbidity index score, and glucocorticoid exposure. No significant differences were observed in ICU admission, 30-day/18-month readmission, and 18-month mortality among patients with known, previously unrecognized and no diabetes (pâ¯≥â¯0.05). CONCLUSIONS: Approximately one in five hematology or oncology inpatients aged ≥54â¯years had known diabetes, and one in fourteen had previously unrecognized diabetes. Those with known diabetes had a longer hospital stay. Routine HbA1c measurement is can be useful for identifying previously unrecognized diabetes, particularly among patients with high glucocorticoid exposure. Further study is required to determine cost-effectiveness in screening for unrecognized diabetes and optimal management of these patients.
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Diabetes Mellitus/diagnóstico , Pruebas Diagnósticas de Rutina , Hemoglobina Glucada/análisis , Enfermedades Hematológicas/sangre , Neoplasias/sangre , Anciano , Anciano de 80 o más Años , Complicaciones de la Diabetes/sangre , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Pruebas Diagnósticas de Rutina/métodos , Femenino , Hemoglobina Glucada/metabolismo , Enfermedades Hematológicas/complicaciones , Enfermedades Hematológicas/diagnóstico , Enfermedades Hematológicas/epidemiología , Hospitalización/estadística & datos numéricos , Humanos , Pacientes Internos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/diagnóstico , Neoplasias/epidemiología , Evaluación de Resultado en la Atención de Salud , Prevalencia , Pronóstico , Centros de Atención TerciariaRESUMEN
BACKGROUND: Polycystic ovary syndrome (PCOS) is a common yet complex condition, where education is vital. It predominantly affects reproductive-aged women, the age group with peak use of the Internet, now a major source of health information. Women with PCOS are dissatisfied with care, and the lack of useful online information is a key concern. METHODS: Using a rigorous and systematic methodology, we examined the quality, information content, and user-friendliness of online information about PCOS. Internet searches were conducted in Australia and the United Kingdom in December 2015 using Google, Bing, and Yahoo with different browsers, operating systems, and domain names. A total of 75 Web sites were evaluated and categorized. RESULTS: The majority of Web sites were commercial (41%) and not-for-profit (76%) and were aimed at women only. Less than a third of the Web sites were externally accredited. Commercial Web sites and Web sites targeting only women had the lowest quality scores, while professional-society Web sites and Web sites targeting only HPs scored the highest in quality. Accredited Web sites had higher quality and user-friendliness scores than nonaccredited Web sites. CONCLUSION: The majority of PCOS Web sites were commercially derived, targeted women, and were not accredited. There is a significant lack of quality, easy-to-read, evidence-based information online for women with PCOS.
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Información de Salud al Consumidor , Internet , Síndrome del Ovario Poliquístico , Australia , Femenino , HumanosRESUMEN
Lifestyle (diet, physical activity [PA], and/or behavioral) interventions are recommended for all women with polycystic ovary syndrome (PCOS) in international guidelines. The internet is a widely used health information resource. However, the accuracy of lifestyle information on PCOS websites is unknown and is reviewed here to inform translation of the international guideline on PCOS. An internet search was conducted with three search engines across different web browsers and countries. Accuracy was assessed through a checklist of 29 questions based on international guidelines for diet, PA, or weight management for the general population and for PCOS with higher scores indicating greater accuracy. Fifteen websites were eligible out of 72 (20%). The total accuracy score was 56 ± 13 (mean ± standard deviation; potential range: -29 to 87) comprising 23 ± 6 for diet (-11 to 33), 15 ± 5 for PA (-9 to 27), and 14 ± 3 for weight management (-8 to 24). A moderate proportion of websites provided general information on appropriate diet (40-80%) or weight management strategies (47-60%), but only 10 to 40% of websites provided information on core foods, discretionary foods, exercise quantity/intensity, energy deficits, or behavioral strategies. Limited websites on PCOS contain information on lifestyle management. The majority provided information on general diet, PA, and weight recommendations but less information on practical implementation of lifestyle change as an identified translation gap for the international guideline on PCOS.
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Dieta , Ejercicio Físico , Internet , Estilo de Vida , Educación del Paciente como Asunto , Síndrome del Ovario Poliquístico , Peso Corporal , Manejo de la Enfermedad , Femenino , HumanosRESUMEN
This study aimed to investigate the use of traditional Chinese medicine and complementary and alternative medicine in stroke patients in Taiwan. Chinese herbal medicine, massage, acupuncture, natural products, and exercise were widely used among stroke patients. Integrating safe and effective traditional Chinese medicine and complementary and alternative medicine into conventional therapies is suggested.
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Terapias Complementarias/normas , Medicina Tradicional China/normas , Accidente Cerebrovascular/terapia , Terapia por Acupuntura/métodos , Terapia por Acupuntura/normas , Adulto , Anciano , Anciano de 80 o más Años , Terapias Complementarias/métodos , Femenino , Humanos , Masculino , Masaje/métodos , Masaje/normas , Medicina Tradicional China/métodos , Persona de Mediana Edad , Encuestas y Cuestionarios , TaiwánRESUMEN
[This corrects the article DOI: 10.1371/journal.pone.0168471.].
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AIMS: The prevalence of diabetes is rising, and people with diabetes have higher rates of musculoskeletal-related comorbidities. HbA1c testing is a superior option for diabetes diagnosis in the inpatient setting. This study aimed to (i) demonstrate the feasibility of routine HbA1c testing to detect the presence of diabetes mellitus, (ii) to determine the prevalence of diabetes in orthopedic inpatients and (iii) to assess the association between diabetes and hospital outcomes and post-operative complications in orthopedic inpatients. METHODS: All patients aged ≥54 years admitted to Austin Health between July 2013 and January 2014 had routine automated HbA1c measurements using automated clinical information systems (CERNER). Patients with HbA1c ≥6.5% were diagnosed with diabetes. Baseline demographic and clinical data were obtained from hospital records. RESULTS: Of the 416 orthopedic inpatients included in this study, 22% (n = 93) were known to have diabetes, 4% (n = 15) had previously unrecognized diabetes and 74% (n = 308) did not have diabetes. Patients with diabetes had significantly higher Charlson comorbidity scores compared to patients without diabetes (median, IQR; 1 [0,2] vs 0 [0,0], p<0.001). After adjusting for age, gender, comorbidity score and estimated glomerular filtration rate, no significant differences in the length of stay (IRR = 0.92; 95%CI: 0.79-1.07; p = 0.280), rates of intensive care unit admission (OR = 1.04; 95%CI: 0.42-2.60, p = 0.934), 6-month mortality (OR = 0.52; 95%CI: 0.17-1.60, p = 0.252), 6-month hospital readmission (OR = 0.93; 95%CI: 0.46-1.87; p = 0.828) or any post-operative complications (OR = 0.98; 95%CI: 0.53-1.80; p = 0.944) were observed between patients with and without diabetes. CONCLUSIONS: Routine HbA1c measurement using CERNER allows for rapid identification of inpatients admitted with diabetes. More than one in four patients admitted to a tertiary hospital orthopedic ward have diabetes. No statistically significant differences in the rates of hospital outcomes and post-operative complications were identified between patients with and without diabetes.
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Diabetes Mellitus/diagnóstico , Hemoglobina Glucada/análisis , Procedimientos Ortopédicos , Automatización , Complicaciones de la Diabetes , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Pruebas Diagnósticas de Rutina , Estudios de Factibilidad , Femenino , Hospitalización , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Prevalencia , Estudios ProspectivosRESUMEN
Polycystic ovary syndrome (PCOS) is a common and complex endocrinopathy with reproductive, metabolic, and psychological features and significantly increased cardiometabolic risks. PCOS is underpinned by inherent insulin resistance and hyperandrogenism. Obesity, more common in PCOS, plays an important role in the pathophysiology, exacerbating hyperinsulinaemia and hyperandrogenism, leading to recommended first-line lifestyle intervention. Significant traditional and non-traditional risk factors are implicated in PCOS in addition to obesity-exacerbated cardiometabolic risks and are explored in this review to promote the understanding of this common metabolic and reproductive condition.